Consent form
I understand that I and the organisation I represent (henceforth referred to as I) are consenting to participate voluntarily in the specific research activity of the European Union-funded project PLATINA4Action (Project number 101137650), as described below.
Project & activity specifics and role of participant
PLATINA4Action aims to accelerate the implementation of green and connected inland waterway transport. Activities will focus on
1) supporting and coordinating research and innovation activities focussing on green and connected IWT to find synergies between parallel developments,
2) impact estimations of NAIADES III actions and supporting the policy discussions to achieve modal shift and zero-emission IWT and
3) the updating of the Strategic Research and Innovation Agenda for IWT.
I will contribute to this research by participating in the Stage Event which aims at gathering feedback and input for the project and at dissemination of results.
The information I provide during the meeting may be used by the project and the outcomes of this interaction could be beneficial for PLATINA4Action.
Disclosure of information
I am free to refuse to disclose information that I feel is commercially or institutionally sensitive or related to topics that I do not wish to discuss, or express that I only want to share certain sensitive information on a bi-lateral non-disclosure basis.
I agree that the result of the research activity will be used for further analysis within PLATINA4Action.
General
My participation in the project is voluntary. I have the right to withdraw from the participation at any time without prejudice. I have the right to ask for additional information at any time and receive understandable and timely answers.
Finally, I have been given the contact details of a PLATINA4Action contact person and I have been informed that I am free to contact this person about any issues or questions I might have related to the project.
| Consent form |
| Project & activity specifics and role of participant |
| I confirm that I have read the information sheet explaining the PLATINA4Action project and I have had the opportunity to ask questions about the project. |
| I confirm that I have read the information under the heading ‘Project & activity specifics and role of participant’ in the PLATINA4Action project. |
| General |
| I confirm that I have read the information under the heading ‘General’ in the informed consent form provided. |
| I confirm that I have read the information sheet and understand what is expected. |
| I confirm that I have had the opportunity to ask any questions and to have them answered. |
| I understand that notes will be taken and that the event, including my participation will be audio recorded, pictures and photos can be made and published, a video is being streamed and recorded and can be broadcasted on-line. |
| I understand that files may be kept. |
| I understand that there is no compensation for participating in the Stage Event. |
| I understand that my participation is voluntary and that I am free to withdraw at any time without giving any reason. |
| I understand that my personal data will be kept treated as confidential. |
| I understand that the information from my participation to the Stage Event will be pooled with other participants’ responses, anonymised, and that general conclusions may be published. |
| I conform that I am an adult. |
| I consent to take part in the Stage Event activity. |
Information sheet
By participation in the PLATINA4Action Stage Event, you can make a key contribution to research and innovation on providing policy advice for a future-ready and sustainable IWT sector. You are kindly asked to read the provided information about this project carefully. Your participation is voluntarily and you do not receive a financial compensation. You are free to ask as many questions as you want before agreeing to the consent form and you are entitled to understandable answers at any time before, during, or after your participation in the Stage Event. You can contact the responsible staff (see below) for any questions before you decide to participate.
| Project Acronym | PLATINA4Action |
| Project Title | PLATform for the Implementation of the Navigation Action programme for Action |
| Project Number | 101137650 |
| Project Duration | 30 months from 01/01/2024 – 31/12/2026 |
| Coordinator |
Name: Martin Quispel Address: EICB, Scheepmakerij 320, 3331 MC, Zwijndrecht Country: The Netherlands E-mail: m.quispel@eicb.nl |
|
Data protection officer (For privacy & personal data related questions) |
Name: Niels Kreukniet Address: EICB, Scheepmakerij 320, 3331 MC, Zwijndrecht E-mail: n.kreukniet@eicb.nl |
Purpose of the research activity
PLATINA4Action aims to accelerate the implementation of green and connected inland waterway transport. Activities will focus on
1) supporting and coordinating research and innovation activities focussing on green and connected IWT to find synergies between parallel developments
2) impact estimations of NAIADES III actions and supporting the policy discussions to achieve modal shift and zero-emission IWT and
3) the updating of the Strategic Research and Innovation Agenda for IWT.
Your participation in this specific PLATINA4Action activity involves the granting of information stemming from specific expertise, your know-how or your network.